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l FOROFFICE USE. x - APPLICATION FOR SANITATION PERMIT Permit No. - .- ---- ----------- (Complefe-in Duplicate) --- ------------------------------------ _--_---- __ This Permit Expires 1 Year From Date Issued Date Issued ___,' � _:. � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ., This application is made in compliance with County Ordinance No. 549. ZI-4f7."( JOB ADDRESS Al' OCATION._ � - � `, : . � 05SS-(7a:7( 0' A `--------------- Owner's Name ------. - --- ------------ -------------------- -- ...... --------------------- ----- -- - Phone.- --------------------------•---- Address ..� --1-••-` +-."'- o, ,----- - -----------------------. I Contractor's Name - --- ------- --- --- ------ ------------------------ Phone----------------- ----------------- I Installation will serve: Residence Apartment House ❑ Commercial I] Trailer Court ❑ otel ❑ Other - I ❑ Number of living units: _1____ Number of bedrooms _ Number of baths- _._ Lot size _- __� j r --�--- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table��__ _ ft I t e Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: (If yes,date______..___,__-.__ ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑� I TYPE OF INSTALLATION AND SPECIFICATIONS': r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! Septic nk: Distance from nearest well___,7'0-----__Distance from foundation_-__1P--------,Material ... - E- r J w No. of compartments-- s� -- --------Size_ '_� 1�-' - - ---Liquid depth--------__---- ------ Ca pacify"-, Dispos Field: Distance from nearest well---, 8......Distance from foundation_____��_� ------Distance to nearest lot line_ -_-I----+;J I Number of lines _- -------3--------------------Length of each line_-. ____--_.__.Width of trench._. .r�.--_--.------__-_-----_� Type of filter material.------ �2_±_______Depth of filter material......f_1_.---.-.--_Total length......�-J4,0_.-.-_----•---------- Seepage Pit: Distance to nearest well_______---------------Distance from foundation--------------------Distance to nearest lot line__-__-_-.____.-__� ❑ dumber of pits--,t------------------Lining material--------- Size: Diameter----------------------Depth-------------- Cesspool: Distance from nearest well ----------------Distance from foundation----------------- . Lining material_....._.................. _______ ❑ Size: Diameter_ J . ------------ --------- - -Depth----------- - ------------------------------------Liquid Capacity------------------------ I -----gau: ' ---------- -------Distance from nearest building Privy: Distance from nearest well �------------ ---------- - g--- - -------- -------- -----------' 1� ❑ Distance to nearest lot line--------------------------- ---- - - Remodeling and/or repairing (describe):-- ------ ----------------- -- ---------------------------------- -------- �. 1 --------------•------------------------------------------------•-------------=-------------- --------------------------------------------------------------------------------------------------------------------- Y. -----------I------------------------------------------------- I------------------------- ----------------------------------------------------------------------------------------------------------------- -------- - - ---------- ! I I hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd ules and regulations of the San Joaquin Local Health District. ` Si ned -- ------- -----------•--- ------------------ � and/or Contractor) B Y•-------------------- - - - -j =4. = - (Title) ------------...----....................(Plot plan, showing size of lot, location of system in relafion o wells, buildings, etc., n`Eie placed on reverse side]. I 1 FOR DEPARTMENT USE ONLY y. APPLICATION ACCEPTED BY_ DATE___, --r -- -------------------------- REVIEWED BY----- - ----- ----------•-------------------------------------------- ---- - ------------------------ ------------- -------- DATE BUILDING PERMIT ISSUED-------- -- - ------------------------------------------------------------------------------------ DATE - -- Alterations and/or recommendations---............... -. ------------------------ ------------------------------------------------------ --------------------- -------------•------ ---- --- ------------------------ ----- ------------------ -------- - ------------------------- ----------------- ------------- ------ ------------------ - ----------------•------------------ - I ---------------- - -------------------- ------------------------------------------------------------ - -------- ---------------------- ---- 1- .......... .................. I -- ----- FINAL INSPECTION BY:-------1`' C ------- Date �- .-._e� ...... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. I t 300 West Oak Sheer 124 Sycamore Street � 205 West 9th Street Slocktan,California Lodi, California Manteca,California Tracy,California 1 E.H.9 2M 1.67 vanguard Press